Can herbal supplements help with IBS better than antibiotics?

Hello,

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A total of five days of antibiotics is good if you feel your symptoms have improved for which you are taking it. IBS (irritable bowel syndrome) has a very close relationship with anxiety and stress. I would suggest probiotics, but I can not assure you about herbal products and their effectiveness. You should work on your anxiety levels. This will improve overall symptoms, and it helps in normalizing stool consistency as well.

Thank you.

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If antibiotics were started because of infective diarrhea, that means you have a history of eating out. Five days of antibiotics should be good. The bowel will take some time to come back to its normal routine. IBS has multiple presentations. One of them is changing the consistency of stools, and symptoms increase with stress. I suggest continuing probiotics for two weeks and avoiding isabgol for some time. This is good for constipation. In your case, it might worsen bowel movements. I hope I have cleared your doubts.

Thank you.

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You can use simple anti-allergic medicines like the tablet Fexofenadine or Hydroxyzine once daily for a few days for itching and red spots, after consulting your doctor. Usually, such itching does not come from the stomach, especially when you have some symptomatic improvement already. However, have you noticed this after any medicine? If yes, then you have to stop that particular medicine. Biots-M (fructo oligosaccride and activated charcoal) is good for the gut, but you can switch your probiotics to other brands if you recently started and feel this itching is somehow related.

Regarding your deworming question, ideally, check your detailed stool report (stool DR) for infection, parasite eggs, or components in your stools. If positive, deworm yourself. We usually deworm children because of their significant exposure to soil and relatively poor hand hygiene practices. In addition, you can deworm yourself if you feel any risk factors, like recent travel or job-related. Last point, if your itching persists after anti-allergic and the red spots worsen, visit a physician for a physical checkup.

Thank you.

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For deworming, take the syrup or tablet Albendazole (benzimidazole carbamate) 400 mg once after consulting your specialist doctor. After that, you can use any of the two anti-allergic tablets I mentioned. After that, you need probiotics probably for a week more. Try to take yogurt daily as well (naturally occurring probiotics).

Hope this helps.

Thank you.

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To check whether the loose stools are infective or not, a stool DR (detailed report) is necessary. If the infection persists, you will need antibiotics; otherwise, you must manage loose stools with simple anti-diarrheal medicine (only recommended in non-infective diarrhea). Stool occult blood is not for loose stools. This is ideally a screening test for occult gastrointestinal blood loss. Later on, we can decide on a colonoscopy. Sometimes it can also be positive in infections because the infection can lead to microscopic blood loss in stools. Other possible situations are if you have taken iron supplements or a diet containing a significant amount of meat one to two days before the test; this can be a false positive too. What are the medicines which you are on for loose stools these days?

Thank you.

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I have reviewed your attached reports (attachments removed to protect the patient's identity). The test is positive for occult blood and red and white blood cells (pus cells). So occult blood detects the heme part of hemoglobin, and hemoglobin is present in the red blood cells. This is positive due to infective diarrhea.

I would recommend the following:

Consult your specialist doctor, talk to them, and take medications after consulting them.

1. Tablet Rifaxamin (antibiotic) 550 mg or 400 mg, whichever is available at your end, twice daily, half an hour after breakfast and dinner for seven days.
2. Continue taking the probiotics too.
3. Repeat your stool DR reports after 7 to 10 days to recheck.

Wishing you great health.

Thank you.

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For IBD, we check for fecal calprotectin levels, not occult blood. However, for cancer, the occult blood test detects microscopic blood loss, which can be due to colonic polyps or lesions. Therefore, occult blood is not a cancer marker; this test only detects a heme portion of hemoglobin in your stools. So technically, it will be positive in case of infections because it causes inflammation and red blood cells to be excreted in stools. As already mentioned, other possible causes are eating meat, iron supplements, even NSAIDs category of painkillers, etc. Treat your loose stools first, and repeat these tests after 7 to 10 days, as suggested. Rifaxamin is an excellent medicine for sub-acute diarrhea. Take this medicine for a couple of days, and once your stools are better, get a retest done. Colonoscopy screening is ideally indicated at a minimum age of 45 years. And earlier with a family history of colon cancer. Before rushing to colonoscopy, you can repeat this test after treating diarrhea.

Wishing you good health.

Thank you.

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Sometimes bacterial infection partially responds to the treatment, and the rest can be taken care of by probiotics even. In your case, stool DR is still showing some white blood cells (pus cells). So a short treatment can be considered. I would suggest the same plan, as I have explained in the previous response.

Thank you.

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I have reviewed your attached reports (attachments removed to protect the patient's identity). The normal fecal calprotectin levels mean there is no ongoing inflammation within the colon, suggesting no IBD or major infection within the colon. You are concerned about the fecal occult blood, so you are asking about colon cancer again. The only definitive test to rule it out 100 percent is a colonoscopy. My clinical suspicion in your case is very low, as I explained before about the occult blood test. I recommend you take good probiotics and a short course of Rifaxamin for seven days and repeat the occult blood test about ten days later from a good laboratory.

Thank you.

Hello,

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No, calprotectin levels are high in colon inflammation like IBD (inflammatory bowel disease) or severe active infections like infective diarrhea.

Thank you.

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Let me explain again,

1) Your stool occult blood was positive on the stool sample, which already contained red and pus cells. When your sample has red blood cells, so by default, occult blood can be positive because occult blood detects the heme part of hemoglobin, which is protein, and it is present within the red blood cells.

2) You are confusing occult blood tests positively with colon cancer by default due to online interpretation without clinical context.

3) Occult blood tests were introduced to check minimal possible blood loss in the colon, so patients should be filtered for colonoscopy with one of the possibilities (out of many) of having colonic polyps or cancer.

4) This test is not diagnostic for colon cancer or polyps, and this has false positive and false negative results too.

5) I mentioned a few conditions like a recent colon infection and the use of certain medications like NSAIDs, group pain killers, Aspirin, a high meat diet, etc., which could lead to false positive results.

6) Fecal calprotectin levels are different tests, and this calprotectin protein is present in white blood cells, not red blood cells. Its raised levels suggest inflammation within the colon due to IBD or infection.

7) Fecal calprotectin will not rule in or rule out colon cancer.

There are two options in your case: Wait and watch, take Rifaxamin and probiotics, and repeat the occult blood test in 7 to 10 days.

And the other is to go for a colonoscopy for your satisfaction. Regarding clinical assessment and impression, I am not expecting colon cancer with this report at such a young age.

This explanation will help you to decide.

Wishing you good health.

Thank you.

Hello,

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Yes, a normal colonoscopy rules out any colon tumor. However, a biopsy is a routine procedure, and we usually do it when we see some inflammation within the colon mucosa. Nonspecific colitis means inflammation within the colon without obvious cause. So if you have the colonoscopy report or picture, I can see the issues, from where they have taken the tissue for biopsy, and the possible clinical cause.

Thank you.

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I have also reviewed your attached reports and colonoscopy pictures (attachments removed to protect the patient's identity). Nothing is alarming. This pattern is very common in recent infective colitis. They have taken tissue for biopsy for inflammation and bowel disease, but these are not typical IBD features. So I am not expecting anything serious in this biopsy. However, you may have mild inflammatory changes related to a recent infection or non-specific colitis. There was no evidence of cancer in this colonoscopy, so relax and do not worry.

Wishing you great health.

Thank you.

Hello,

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Yes, these focal erythematous changes are due to a recent infection rather than IBD. I expect nothing serious at your age with otherwise normal health status. I have reviewed your colonoscopy report, and there was no mass lesion or cancer. They have done a biopsy to check this focal erythematous area. We usually perform biopsies when we find any mucosal abnormalities like inflammation, erythema, etc.

Kind regards,

Thank you.